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The Hidden Costs of School Shootings

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From the WebMD Archives

Sept. 9, 2021 -- Heather Martin and her choir classmates were doing vocal warmups at Columbine High School on a spring morning in 1999 when a student burst into the room, warning about gunshots downstairs. Soon, Martin recalls, a teacher rushed in and told the class, “‘They’re coming up the stairs. You have to hide.’”

Martin, then a 17-year-old senior, crammed into the second-floor choir office with 59 other students. They barricaded the door. Fire alarms were blaring, but they could hear gunshots and screams, perhaps from the hallways or the nearby library.

In the packed office, “Kids were crying, praying, hugging each other, talking to each other, but also trying to remain quiet,” Martin says. As time dragged on, the room grew hot. Students climbed up and removed ceiling tiles to fan the room. Then they had another idea: They wrote their names on the ceiling tiles.

“In case something should happen, people would know that we were there,” Martin says, her voice still catching slightly after 22 years.

The students huddled for 3 hours before a SWAT team reached them and escorted them from the building. The Columbine assailants, two boys from Martin’s senior class, had taken their own lives after killing one teacher and 12 students and wounding many more. Martin wasn’t physically injured, nor had she lost anyone close. But as an indirect victim, she struggled with the psychological fallout for years.

In the 2 decades since the Columbine High School shooting in Littleton, CO, gun violence has continued to plague U.S. schools. Not all are mass shootings like Columbine, Sandy Hook, or Parkland. Some involve a single fatality, such as the recent death of Bennie Hargrove, a 13-year-old middle school student in Albuquerque, NM. He died Aug.13 after a classmate shot him during their lunch break, only 3 days into the new school year. According to news reports, witnesses told police that the shooter, also 13, opened fire after Hargrove told him to stop bullying a friend.

No federal agency tracks school shootings. But according to research from The Washington Post, since Columbine, an estimated 256,000 children at 278 schools have been exposed to gun violence during school hours.

This year has offered no respite. Since March, when schools began reopening after pandemic shutdowns, at least 14 school shootings have occurred, the Post reported.

Some experts worry that the stress of the pandemic could heighten risk for more campus shootings.

According to the Post’s database, 151 students, teachers, and others have been killed and 323 have been injured in school shootings since 1999. Media attention typically focuses on the injured or deceased or on families that have lost loved ones. Less attention falls on the many children and teens who emerge physically unharmed but are often psychologically scarred.

Emerging Research

This growing group requires deeper understanding, according to Maya Rossin-Slater, PhD, a health economist and associate professor at the Stanford University School of Medicine. She and her colleagues have begun studying the psychological and educational paths of U.S. students who have experienced school shootings.

The gun violence they examined included “incidents where somebody brings a gun to school and the gun is fired, whether that’s during a fight or maybe a suicide that happens on school grounds,” Rossin-Slater says.

Shootings might be indiscriminate or personally targeted, or they could occur during a crime, such as a robbery.

“These types of events don’t tend to be covered very much by media outlets because they’re not as dramatic as mass shootings,” she says. “Nevertheless, what we’re finding is that because these events are a lot more frequent, a lot of kids are exposed.”

In a 2019 study, her research team examined youth antidepressant use after 44 fatal school shootings in the U.S. between 2008 and 2013.

In the 2 years after the shootings, antidepressant prescriptions for those under age 20 were 21% higher in the neighborhoods within 5 miles of campus, compared to areas 10 to 15 miles farther away. Proximity matters.

“Fatal shootings have large and persistent impacts on the mental health of local youth,” wrote Rossin-Slater and her fellow researchers from Stanford, Yale, and Northwestern universities.

Their study focused solely on antidepressants, but these drugs are prescribed not only for depression, but also for anxiety and posttraumatic stress disorder (PTSD).

“It’s sort of an all-encompassing measure of treatment for mental health, but it’s not perfect because we’re not able to capture, for instance, the underlying incidence of these conditions,” Rossin-Slater says.

A Range of Experiences

During a school shooting, “not everyone has had the same experience,” says Melissa Brymer, PhD director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress. Some students have witnessed people being shot or provided first aid to the injured, while others might have been in unaffected parts of a building and had no idea what was happening when they evacuated. Some students might have lost family members, friends, a boyfriend or girlfriend, or a beloved teacher.

Brymer has worked with numerous communities after school shootings, from a 2001 shooting at Santana High School in Santee, CA, that killed two students and wounded 13, to the 2012 tragedy at Sandy Hook Elementary School in Newtown, CT. That shooting took the lives of 20 students and six staff members.

Just after such shootings, survivors will feel a range of emotions, she says, including “sadness, grief, anger, confusion on why this could happen here, or being afraid that it could happen again.”

People become hyper-vigilant, too, she says. “Our bodies go on alert. ‘Wherever I am, is it safe?’”

Sleep disruptions become commonplace, Brymer says, “whether it’s not being able to fall asleep or having nightmares or just not having restful sleep.”

While some students will lean on peers for support, she says, others “isolate and distance themselves from others.”

If students develop PTSD, they may have a variety of symptoms: intrusive memories or flashbacks of the event, nightmares, always being on guard against danger or being easily startled, crankiness, a hard time feeling positive emotions, feeling emotionally numb, or trying to avoid people or places that are reminders of the event.

‘Unsafe and Terrified’

Martin, now 40, still lives in the Denver area. She remembers being so frightened right after the shooting that she and her younger sister, a freshman at the time, started sleeping in the same bed with the lights on. If Martin needed to go to the bank or gas station, her sister always went with her.

“I felt completely unsafe and terrified that I would be alone if that happened again,” she says.

She can’t recall if she had nightmares, she says. Rather, she had a vivid image that she knows wasn’t a true memory, “but it’s like a representation of how I felt.”

In reality, the choir kids had been sitting cross-legged on top of each other to stay away from the office door. “But in my mind, I’m standing up in the middle of all these people sitting down and I’m crying all by myself. That feeling of isolation and being alone started happening right away.”

Martin and the other students finished the academic year at another high school in town. Later, she saw a private counselor four or five times. But looking back, she had minimized her trauma, she says, even though she had feared for her life.

“I wasn’t physically injured, and I didn’t lose a loved one. I thought: ‘Somebody has it worse. I don’t have a right to struggle.’”

But she endured many struggles when she went to a local community college. She had trouble coping emotionally.

“I remember feeling isolated, lonely, angry -- oh, my gosh, so angry.”

She developed an eating disorder and dabbled in recreational drugs.

Still, she dismissed the role of trauma.

“I know I’m not OK, but I was refusing to believe that it had to do with Columbine. It had been a year.”

In retrospect, she says, “That’s laughable.”

At college, traumatic memories intruded. About 6 months after the shooting, she was sitting in a college English class when the fire alarm sounded during a routine drill.

“It was the first time I was blindsided by a trigger,” she says. “I just started sobbing in the middle of my English class.”

She remembered the other students staring at her in confusion.

There were other reminders. The Columbine killers had shot many of their victims in the school library. When a professor assigned a paper that involved library research, Martin told him, “I have a really hard time in libraries, particularly school libraries.”

When she tried going into the campus library, she recalls, “I’m sitting there staring at the exit. My heart rate is elevated. There’s no focusing going on because I keep looking at the entrance.”

The professor allowed her to turn in her paper without going to the library.

“My memory is really bad from probably that first year or two,” she says. “It’s trauma. It’s hard to concentrate. It’s hard to focus on something that doesn’t seem like a priority at that moment. You have to feel safe to learn, and your sense of safety is completely shattered.”

She was never diagnosed with anxiety, depression, or PTSD, but a couple of years after the shooting, she developed anxiety attacks.

“Mine were so all-compassing that I would curl up with pain in my abdomen and start hyperventilating and couldn’t talk,” she says. “They were really debilitating.”

After 2 or 3 years -- she says she can’t recall exactly -- she dropped out of college and got a job at a restaurant.

Academic Problems

Martin’s academic struggles after a school shooting aren’t surprising. In a 2021 study, Rossin-Slater and researchers at the University of Texas and at Northwestern University looked at 33 public schools in Texas where shootings had taken place between 1995 and 2016, not all of them involving fatalities.

“We found that exposure to shootings at schools leads to a higher likelihood that kids are absent from school, they’re more likely to repeat a grade, they’re less likely to graduate from high school, they’re less likely to go to college, and when they’re in their mid-20s, they have lower earnings,” Rossin-Slater says.

The study found that such students were 6% less likely to be employed between the ages of 24 and 26. Those who held jobs earned 13% less than students who had attended similar schools without a shooting.

School gun violence, Rossin-Slater says, “is really costly in terms of the kids’ mental health, in terms of their future educational and economic trajectories.”

Some children might be too frightened to attend class. In the years after the 2012 Sandy Hook attack, standardized English and math scores fell substantially throughout the school district, according to Wellesley College researchers Phillip Levine, PhD, and Robin McKnight, PhD, with math scores tumbling by roughly 30%.

The two economists attributed much of the decline to chronic absenteeism, which more than doubled at Sandy Hook Elementary in the year after the shooting. Students were also absent at other elementary schools in town, but not to the same degree.

‘Numb’ to the Emotions

Noel Sudano, 38, remembers much academic disruption among her peers at Columbine: students who opted to learn from home, others whose grades dropped, or those who came to class only now and then.

One good friend, who had to step over a victim’s body on the way out of the building, struggled when school resumed in the fall.

“That junior year for her was awful,” Sudano says. “I remember her just not attending very much. She was in my chemistry class, and I think I saw her maybe once a week, if that.”

Sudano, who was a 16-year-old sophomore during the shooting, had run from math class on a teacher’s orders, abandoning her belongings and feeling too terrified to even look behind her. When she was allowed back that summer to collect her things, the setting was frozen in time.

“My book was open on the desk, a pencil was sitting in the divot, my purse was still there. It was really eerie,” she says.

The school still bore the marks of a crime scene: lockers with bullet holes in them, and areas that SWAT teams had marked as all clear after searching for bombs.

When she sat in class again, anxious thoughts swirled: “OK, am I really here? Is it OK? Are we safe here?”

More tragedy rocked the school that first year. Greg Barnes, a gifted 17-year-old athlete in Sudano’s graduating class, took his life about a year after the shooting.

“He was a basketball player, appeared to have everything. That hit us pretty hard. That was really shocking,” she says.

After graduation, Sudano decided to attend a small university in Idaho, motivated in part to escape the overwhelming grief and trauma in Littleton.

“I didn’t realize it at the time, but that was a big driver for me going out of state to college. I just felt like this is too much, I can’t sort out my thoughts around everyone who’s going through their own pain.”

Sudano left Colorado and poured her energies into studying at college. By junior year, though, her motivation had flagged.

“I was just feeling lethargic and uninspired,” she says.

She sought counseling after feeling so low that academics were no longer a buffer.

“I used that to avoid feeling all of the pain that I knew was in there, but it caught up with me, and that was OK. The timing -- I don’t think that it was unhealthy. I think I just needed space before I was really ready to process it.”

In Brymer’s research on 10 communities that had suffered mass violence, she found similar delayed reactions -- students who didn’t acknowledge the effects of trauma until halfway through college. Some thought that the best approach was to keep pushing forward, only to realize later that they needed help, she says. Some felt undeserving.

Sudano also minimized her trauma and wrestled with survivor’s guilt, which can happen after people have lived through a life-threatening situation. They often question why they survived when others died and what they could have done differently, even to the point of over-analyzing the event when they did nothing wrong. Survivor’s guilt can signal PTSD.

Many students, like Martin, had been trapped inside the school for hours. Sudano faulted herself for running from math class and not “going around and knocking on other classrooms to make sure people were getting out. ‘I should have done more. I should have been looking out for other people instead of just myself.’”

But she has since made peace with her 16-year-old self.

“You know what you know in the moment,” she says. “I didn’t really understand what was happening in the moment as I was running out of the building.”

Reminders of Trauma and Loss

Students, parents, teachers, staff, and communities often react to school shootings with shock and disbelief. Many never thought such a crime could happen in their midst.

Brymerm, from the National Center for Child Traumatic Stress, warns that in the aftermath, many survivors will face common experiences.

For example, they might encounter trauma reminders that bring back harrowing memories. For Martin, it was the sound of a fire drill at college. For others, the triggers could be police or ambulance sirens, helicopters overhead, fireworks, or another school shooting in the news. Even a student popping a chip bag in the cafeteria can bring back memories of gunshots, according to Brymer.

Students will also face reminders of loss.

Students might show various symptoms, depending on their age and individual experience of the shooting. They might have intense emotional upset, symptoms of anxiety or depression, trouble with academics or relationships, and physical signs that include aches and pains. Older children might behave in risky ways, including use of drugs or alcohol.

“Kids do cope by using substances to numb themselves, to cope with the reactions that they’re experiencing.” Brymer says.

“And we do worry about suicide,” she says. “On anniversaries, people worry about another incident happening. Those of us that do this work, we know that this is an increased time for suicide.”

Nowadays, she faces a newer foe: social media falsehoods. That includes conspiracy theories that distort shootings as hoaxes, a hurtful and confusing phenomenon, she says. “The kids ask, ‘Why are people saying this didn’t happen? Don’t they like us?’”

Brymer instructs students on using social media in a healthy way, including steering clear of videos and comments that could be upsetting. “It’s one part of my job that I did not expect but is now becoming commonplace. People think it’s just Sandy Hook and Parkland, and it’s not.”

The pandemic might pose dangers, too, as more youths have faced economic insecurity and mental health problems.

“That concerns me, because that could increase the risk that gun violence takes place,” Rossin-Slater says.

Already, gun assaults have occurred on reopened campuses. In North Carolina, two recent high school shootings occurred within 3 days, and one led to a student’s death. Both schools were locked down.

The Road Ahead

For many, the road is long.

The Columbine shooting happened on the 20th of April.

“I still get a little bit anxious or snippy or don’t sleep that well. I feel a lot of relief after that day passes,” Martin says.

She worked in the restaurant industry for a decade before going back to college in her late 20s. She’s now an English teacher at a high school in Aurora, CO, and some of her students know that she’s a Columbine survivor.

After a mass shooting at the Century 16 theater in Aurora in July 2012, Martin co-founded The Rebels Project, named after the Columbine mascot. The nonprofit organization offers support to survivors of mass violence. Along with other volunteers, Martin seeks to be “someone who provides hope, because it does get better and there are times when you don’t believe that,” she says.

Sudano still lives in the Denver area and is the mother of two elementary school-age children.

She knows of former schoolmates who haven’t fared well. Some were wracked with intense survivor’s guilt and developed “pretty scary addiction issues,” she says. “One had like five DUIs, and he’s now facing sentencing because he just can’t get his issues under control.”

But from such a dark and ruinous day in 1999, a powerful memory still echoes. Sudano and other students had run from the Columbine campus to gather at a park across the street, unsure of what was happening inside the building.

“There were lots of people crying, and there was so much confusion,” she says.

Then she looked up and saw teachers lining the sidewalk facing the school, “without question creating this shield of protection,” she says. “I was struck by the fact that they were in this unknown, scary situation, just like we were, and they snapped into action and did what they felt they needed to do to protect their students. It looked like they didn’t hesitate.”

WebMD Health News


Heather Martin, English teacher, Aurora, CO.

Noel Sudano, school counselor, Littleton, CO.

Maya Rossin-Slater, PhD, health economist and associate professor, Stanford University School of Medicine.

Melissa Brymer, PhD, PsyD, director, terrorism and disaster programs, UCLA-Duke National Center for Child Traumatic Stress.

National Bureau of Economic Research Working Paper Series, December 2019: “Local Exposure to School Shootings and Youth Antidepressant Use.”

National Bureau of Economic Research Working Paper Series, December 2020: “Trauma at School: The Impacts of Shootings on Students’ Human Capital and Economic Outcomes,” “Exposure to a School Shooting and Subsequent Well-Being.”

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